Journal of Parenteral and Enteral Nutrition最新文献

{"title":"Development of home-based methods to defat human milk for infants with chylothorax: An experimental study","authors":"Kaitlin Berris RD,&nbsp;Kendall Plant BSc,&nbsp;Frances Jones IBCLC,&nbsp;Diego Marquez MD,&nbsp;Vicki Hsieh RN,&nbsp;Rajavel Elango PhD","doi":"10.1002/jpen.2782","DOIUrl":"10.1002/jpen.2782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chylothorax is a postoperative complication for infants with congenital heart defects; with high nutrition risk. Defatted human milk is recommended; however, refrigerated centrifugation to process milk poses accessibility barriers for many hospitals and families at home. Creation of a simplified home-based defatted milk protocol allows infants with chylothorax to be provided the immunological benefits of human milk postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Milk from 20 mothers was tested to compare refrigerated centrifugation as the standard defatting technique against gravity-based methods: syringe tip-down and gravy separator. Two timeframes, 24 h and 48 h, were tested to determine if additional time had a significant impact on fat reduction. The MIRIS human milk analyzer provided results for fat, true protein, carbohydrate, and energy content. One-way analysis of variance was used to determine a significant difference on fat content among methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All methods had a significant reduction in fat content, with centrifugation having the largest mean decline from 3.4 to 0.5 g/100 ml (<i>P</i> &lt; 0.0001). The second most effective method to defat milk was 48-h gravy separator with a mean decline to 0.7 g/100 ml (<i>P</i> &lt; 0.0001). Postpartum age of milk impacted the degree of fat removal in all methods. True protein content remained the same as baseline in all methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A simplified home-based gravity separation method over 48 h reduced human milk fat by 80%. This is the first protocol to defat human milk without use of the more resource-intensive centrifugation method, that shows significant fat reduction with easy-to-use and accessible equipment for management of infants with chylothorax.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"724-731"},"PeriodicalIF":4.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between insulin dose and hyperglycemia in hospitalized adults with ischemic stroke receiving continuous enteral nutrition: A retrospective cohort study","authors":"Heather M. Wallhauser PharmD,&nbsp;Leslie A. Hamilton PharmD,&nbsp;Skyler R. Brown PharmD,&nbsp;Thomas J. Christianson MD,&nbsp;Brian F. Wiseman MD,&nbsp;Olivia N. Bray PharmD,&nbsp;Hayden W. Caldwell PharmD,&nbsp;A. Shaun Rowe PharmD","doi":"10.1002/jpen.2787","DOIUrl":"10.1002/jpen.2787","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hyperglycemia following an acute ischemic stroke has been linked to increased morbidity and mortality. Because of changes in a hospital-wide sliding-scale insulin protocol to incorporate half-doses at midnight due to hypoglycemia risk, we aimed to evaluate the safety and efficacy of half-dose sliding-scale insulin at midnight compared with full doses in patients with acute ischemic stroke receiving enteral nutrition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective cohort study involved 151 patients with acute ischemic stroke and receiving enteral nutrition in a neurocritical care unit between January 1, 2014, and December 31, 2021. The exposure of interest was half-dose sliding-scale insulin at midnight compared with full-dose sliding-scale insulin at midnight. The primary outcome was the incidence of hyperglycemia for a 48-h period after stability while receiving enteral nutrition. Secondary outcomes were new infections, incidence of hypoglycemia, and incidence of delirium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the full-dose group, 52 patients experienced hyperglycemia compared with 60 patients in the half-dose group; however, after propensity matching for carbohydrate content in enteral nutrition and hemoglobin A1c, the results are not noninferior (risk difference, 3.9%; 95% CI, −21.2% to 13.3%; <i>P</i> = 0.1041). Delirium was significantly higher in the full-dose group, whereas the half-dose group had a higher rate of suspected bacterial infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study indicates that administering half-dose sliding-scale insulin at midnight in patients with acute ischemic stroke receiving enteral nutrition is not noninferior to full doses in controlling hyperglycemia. However, differences in delirium and infection rates suggest that glycemic changes may influence other outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"752-757"},"PeriodicalIF":4.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of catheter-related bloodstream infections with sodium citrate lock therapy in adult patients receiving home parenteral nutrition: A descriptive cohort study","authors":"Rachel Leong PharmD,&nbsp;Nisha J. Dave PharmD,&nbsp;Daniel P. Griffith RPh,&nbsp;Anna Guo MS,&nbsp;Kirk A. Easley MS,&nbsp;John R. Galloway MD,&nbsp;Thomas R. Ziegler MD,&nbsp;Vivian M. Zhao PharmD","doi":"10.1002/jpen.2788","DOIUrl":"10.1002/jpen.2788","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We determined the incidence of catheter-related bloodstream infections in adult patients requiring home parenteral nutrition (HPN) while receiving sodium citrate locks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center descriptive cohort study involving 38 adults who required HPN from January 1, 2020, to August 31, 2022. The exact method, assuming a Poisson distribution, was used to estimate the incidence rate of catheter-related bloodstream infections per 1000 catheter days among patients receiving sodium citrate locks. Univariate and multivariate analyses using Poisson regression and frailty models were employed to evaluate predictive factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-eight patients received sodium citrate locks, with 65.8% women (mean age, 50.2 ± 14.5 years). The average length of HPN was 3.6 years. Forty-six catheter-related bloodstream infections occurred during 20,085 catheter days, demonstrating an incidence rate of 2.3 (95% confidence interval, 1.7–3.1) per 1000 catheter days. Peripheral-inserted central catheters had a higher incidence rate (3.9 per 1000 catheter days) than Hickman catheters (2.2 per 1000 catheter days), with a hazard ratio of 1.27, indicating a 27% increased risk of catheter-related bloodstream infections. Univariate and multivariate Poisson regression analyses revealed that for every 1-h increase in HPN infusion duration (h/day), the incidence rate of catheter-related bloodstream infections is expected to increase by 10%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Catheter-related bloodstream infections are common in adult patients requiring HPN. Sodium citrate locks may help prevent these infections. Recognizing predictive factors, such as the duration of parenteral infusion, can help healthcare providers develop more effective prevention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"783-790"},"PeriodicalIF":4.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential fatty acid deficiency in children treated with long-term 100% fish-oil lipid injectable emulsion: A longitudinal descriptive cohort study","authors":"Kathleen M. Gura PharmD,&nbsp;Muralidhar H. Premkumar MBBS,&nbsp;Kara L. Calkins MD,&nbsp;Mark Puder MD, PhD","doi":"10.1002/jpen.2785","DOIUrl":"10.1002/jpen.2785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To assess severity and risk of an essential fatty acid deficiency in children &lt;2 years with parenteral nutrition–associated cholestasis on long-term 100% fish-oil lipid injectable emulsion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal descriptive cohort study included patients receiving fish-oil lipid injectable emulsion (1 g/kg/day). Triene: tetraene ratios were monitored for up to 4 years and classified as mildly elevated (≥0.05 and &lt;0.2) or essential fatty acid deficiency (≥0.2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and twenty-seven patients with a baseline median age of 14 weeks were included. Serum docosahexaenoic acid and eicosapentaenoic acid levels markedly increased, whereas arachidonic acid, linoleic acid, and α-linolenic acid levels decreased before stabilizing. Median triene: tetraene ratios peaked at 0.027 at week 8 and then stabilized within a range of 0.015 and 0.020 from week 16 until the end of the study. Seven patients had mildly elevated triene: tetraene ratio at the end of the study. Three infants had an essential fatty acid deficiency, but none demonstrated clinical signs consistent with this deficiency. One deficiency was attributed to a laboratory error; two were associated with adverse events. All patients resolved with the continuation of fish-oil lipid injectable emulsion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children with parenteral nutrition–associated cholestasis on long-term fish-oil lipid injectable emulsion are at low risk for a clinical or biochemical essential fatty acid deficiency. These findings indicate that despite its low content of linoleic acid and α-linolenic acid, long-term 1 g/kg/day of 100% fish-oil lipid injectable emulsion is not associated with an essential fatty acid deficiency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"732-740"},"PeriodicalIF":4.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parenteral nutrition weaning in pediatric intestinal failure patients enrolled in remote patient monitoring: A descriptive study","authors":"Stephanie B. Oliveira MD,&nbsp;Julia D. Thomas BA,&nbsp;Conrad Cole MD,&nbsp;Michael Helmrath MD,&nbsp;Samuel Kocoshis MD,&nbsp;Paul W. Wales MD","doi":"10.1002/jpen.2784","DOIUrl":"10.1002/jpen.2784","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Remote patient monitoring (RPM) enhances patient surveillance. This study describes our initial experience with RPM in pediatric intestinal failure patients and its preliminary impact on parenteral nutrition (PN) reduction in an outpatient setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a descriptive cohort study on pediatric patients with intestinal failure receiving home PN and enrolled in an RPM program managed by our intestinal rehabilitation team. Initiated in March 2021, the study compared PN energy and volume reduction rates before and after RPM implementation. We calculated the rate of PN decrease per day and the time to achieve a 20% reduction in PN volume. Paired <i>t</i> tests were used for comparisons. Statistical significance was set at <i>P</i> &lt; 0.05. The study received institutional review board approval.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen patients were included (52% male; mean age: 44 months). The most common etiology of short bowel syndrome was necrotizing enterocolitis (NEC), with a mean residual small bowel length of 15.5% ± 12.5%. Post-RPM, there was a greater reduction in PN energy and volume (0.22 ± 0.28 and 0.17 ± 0.24) compared with pre-RPM (0.08 ± 0.10 and 0.07 ± 0.08), though not statistically significant (<i>P</i> = 0.11 and <i>P</i> = 0.17). Time to achieve a 20% reduction in PN was shorter post RPM but not statistically significant (<i>P</i> = 0.06 and <i>P</i> = 0.20 for energy and volume, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Remote patient monitoring appears safe for pediatric intestinal failure patients, with potential for higher PN reduction and shorter time to achieve it. Further research is needed to fully assess RPM's impact on this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"768-772"},"PeriodicalIF":4.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2784","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor human milk storage and gastrointestinal morbidities in preterm infants: A case-control study","authors":"Terence James M. Camilon MS,&nbsp;Mary Galemmo BS,&nbsp;Whitney Savino NNP,&nbsp;Allison Rohrer RD,&nbsp;Mathew J. Gregoski PhD,&nbsp;Aaron P. Lesher MD,&nbsp;Katherine E. Chetta MD","doi":"10.1002/jpen.2780","DOIUrl":"10.1002/jpen.2780","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prolonged storage of donor human milk may alter its bioactive components, potentially affecting preterm infant outcomes. No prior studies have examined the impact of donor human milk storage duration on necrotizing enterocolitis or spontaneous intestinal perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a retrospective case-control study (February 2022 to January 2024) at a single neonatal intensive care unit, we evaluated preterm infants (&lt;32 weeks' gestational age or birth weight &lt;1700 g) receiving donor human milk. Cases (<i>n</i> = 36) had necrotizing enterocolitis (Bell stage ≥2A) or spontaneous intestinal perforation; controls (<i>n</i> = 226) were disease free. Donor human milk storage duration (days from expression to consumption) was calculated using lot expiration dates. Logistic regression assessed associations, adjusting for gestational age, birth weight, and other confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 262 infants, 36 developed necrotizing enterocolitis (<i>n</i> = 28) or spontaneous intestinal perforation (<i>n</i> = 8). Mean donor human milk storage duration was 258.6 (SD, 29.9) days in cases and 244.5 (SD, 21.7) days in controls (<i>P</i> = 0.01). Each additional storage day increased the adjusted odds of necrotizing enterocolitis or spontaneous intestinal perforation by 3.6% (95% confidence interval, 1.17–5.5; <i>P</i> &lt; 0.001), after accounting for maternal and infant comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prolonged donor human milk storage is associated with necrotizing enterocolitis and spontaneous intestinal perforation in preterm infants, particularly those &lt;750 g. These findings suggest a need to reevaluate donor human milk storage guidelines for high-risk neonates, pending multicenter validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"717-723"},"PeriodicalIF":4.1,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between multioil intravenous lipid emulsion and cholestasis in infants with gastrointestinal disorders: A retrospective cohort study","authors":"Lauren J. Lee MD, MS,&nbsp;Esther S. Kim MD,&nbsp;Tahmineh Romero MS,&nbsp;Kara L. Calkins MD, MS","doi":"10.1002/jpen.2776","DOIUrl":"10.1002/jpen.2776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Infants with gastrointestinal (GI) disorders are at risk for parenteral nutrition–associated cholestasis. A multioil intravenous lipid emulsion (MO ILE) contains less phytosterols and more arachidonic and docosahexaenoic acid (DHA) than 100% soybean oil lipid emulsion (SO ILE). This study compares parenteral nutrition–associated cholestasis, growth, and fatty acids in infants with GI disorders who received MO ILE or SO ILE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 48 infants with GI disorders born between 2014 and 2022 who received an intravenous lipid emulsion for ≥14 days. Cholestasis was defined as serum conjugated bilirubin<i> ≥</i>2 mg/dl; growth was assessed by z score changes. Gas chromatography and mass spectrometry was used to measure fatty acid content in the erythrocyte cell membrane.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of parenteral nutrition–associated cholestasis was similar (MO ILE 30% vs SO ILE 29%, <i>P</i> &gt; 0.99). However, compared with infants who received parenteral nutrition &gt;28 days and SO ILE, infants who received parenteral nutrition &gt;28 days and MO ILE experienced a slower rise in conjugated bilirubin (0.1 ± 0.03 vs 0.26 ± 0.38 mg/dl, <i>P</i> interaction &lt; 0.001). Weight <i>z</i> score decline (discharge to birth) was less in the MO ILE group vs SO ILE group (−1.0 [−2.0, −0.4] vs −0.4 [−0.9, 0], <i>P</i> = 0.04). Although the MO ILE group demonstrated improved DHA status at weeks 1–3 (<i>P</i> &lt; 0.05 for all), arachidonic acid and DHA decreased over time in both groups and there was no difference in the rate of change (<i>P</i> interaction &gt; 0.3 for both).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In infants with GI disorders, MO ILE was associated with improved growth. MO ILE was well tolerated and hepatoprotective in infants who required prolonged parenteral nutrition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"707-716"},"PeriodicalIF":4.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of early compared with delayed initiation of feeding after placement of percutaneous endoscopic gastrostomy tube: A systematic review and meta-analysis","authors":"Mudathir Ibrahim MD,&nbsp;Ceilidh McKenney MD,&nbsp;Camilla Sophia Rossi MD,&nbsp;Susan Khader Ibrahim BDS, MSc,&nbsp;Ahmed Alnajar MD, MSPH, MS-BST,&nbsp;Gianmarco Cancelli MD,&nbsp;Matthew McKenney MS,&nbsp;Michelle Demetres MLIS,&nbsp;Zi Yuan MD, MPH,&nbsp;Jeffrey Nicastro MD, FACS,&nbsp;Joel Horovitz MD, FACS","doi":"10.1002/jpen.2774","DOIUrl":"10.1002/jpen.2774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Certain guidelines consider feeding within 4 h of percutaneous endoscopic gastrostomy tube (PEG) placement to be safe. However, the evidence supporting the recommendations has been questioned and variation in feeding initiation practices persists, with feeding delayed up to 24 h after PEG placement. Our objective was to systematically review the current literature on early vs delayed feeding after PEG placement and compare their outcome in a meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ovid MEDLINE, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched from inception until December 4, 2023. Randomized and nonrandomized studies comparing feeding initiation ≤4 vs &gt;4 h post-PEG in adults were included. Independent extraction was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines and data were pooled using fixed or random-effects models. Measured outcomes were the odds of postoperative vomiting, diarrhea, stoma leakage, stoma infection, bleeding, intra-abdominal infection, aspiration pneumonia, and 30-day mortality. Assessment of risk of bias was completed using the Cochrane risk of bias tool 2 (RoB 2) for randomized studies and the Newcastle-Ottawa scale for nonrandomized studies. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42023483520.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4751 studies, 11 with 2880 patients met inclusion. There was no significant difference in all the measured outcomes between groups, but the evidence certainty was low to very low. Intra-abdominal infection couldn't be examined because of scarce reporting by authors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This robust meta-analysis suggests early feeding after PEG placement is likely safe but uncertain, highlighting the need for a high-quality randomized trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"682-691"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term home parenteral nutrition in chronic intestinal failure following metabolic and bariatric surgery and its clinical outcomes: A descriptive cohort study","authors":"Dane Christina Daoud MD,&nbsp;Katherine J. P. Schwenger RD, PhD,&nbsp;Yasaman Ghorbani MSc,&nbsp;Leah Gramlich MD,&nbsp;George Ou MD,&nbsp;David Armstrong MD,&nbsp;Maitreyi Raman MD,&nbsp;Johane P. Allard MD,&nbsp;Barbara Bielawska MD, MSc","doi":"10.1002/jpen.2772","DOIUrl":"10.1002/jpen.2772","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic and bariatric surgery is one of the most efficacious treatments for obesity. The increasing incidence of referrals to intestinal rehabilitation programs and the necessity for long-term parenteral nutrition because of bariatric surgery complications have gained attention, yet data remain limited. Our objectives were to (1) assess parenteral nutrition-related complication rates of patients requiring long-term parenteral nutrition because of bariatric surgery complications and (2) compare outcomes between types of metabolic and bariatric surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a descriptive cohort (<i>n</i> = 25) study, which gathered data from patients enrolled in the national registry with a history of metabolic and bariatric surgery at baseline and 2 years and included demographics, biochemical parameters, parenteral regimens, line sepsis, hospitalizations, and functional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study, 92% were women with a mean age of 53.8 ± 8.6 years. The most prevalent procedure performed was Roux-en-Y gastric bypass (60%). Short bowel syndrome was observed in 40% of our cohort (<i>n</i> = 10). After 2 years, there was a significant reduction in the need for parenteral nutrition compared with baseline, with 37.5% of patients achieving weaning. No significant disparities were observed in the incidence of line sepsis, hospitalizations, or Karnofsky performance status between baseline and the 2-year follow-up, regardless of the type of surgery. Roux-en-Y gastric bypass was associated with lower body mass index at the 2-year mark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In post-metabolic and bariatric surgery patients, long-term parenteral nutrition is well tolerated based on clinical outcomes and functional status is not influenced by the type of surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"773-782"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between handgrip strength asymmetry and all-cause mortality in United States–based older adults: A cross-sectional study","authors":"Xiufang Kong MD, PhD,&nbsp;Wei Wang MD, PhD","doi":"10.1002/jpen.2777","DOIUrl":"10.1002/jpen.2777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although handgrip strength is commonly measured in both hands for sarcopenia screening, the nonmaximum readings are frequently discarded. We aimed to evaluate whether handgrip strength asymmetry, in addition to weakness, could provide additional prognostic information in older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants aged ≥60 years from the 2011–2014 National Health and Nutrition Examination Survey with available handgrip strength measurements were included. Study outcomes are all-cause and cardiovascular disease mortality. Participants were categorized into the weakness−/asymmetry− (reference), weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups based on the status of handgrip weakness and asymmetry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 3116 older adults (mean age, 69.47 years) were included. Weighted percentages of participants in the reference, weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 54.28%, 39.88%, 2.86%, and 2.97%, respectively. During a median follow-up of 79 months, 679 deaths (232 from cardiovascular causes) occurred. Compared with the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for the weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 1.02 (95% CI 0.84–1.24), 1.57 (95% CI 1.09–2.26), and 2.34 (95% CI 1.47–3.71), respectively, for all-cause mortality (<i>P</i> for trend &lt; 0.01) and 1.19 (95% CI 0.78–1.81), 1.22 (95% CI 0.54–2.78), and 2.30 (95% CI 1.20–4.39), respectively, for cardiovascular disease mortality (<i>P</i> for trend = 0.03). Subgroup analysis indicated anemia and diabetes significantly modified the associations between handgrip strength and/or weakness status with all-cause and cardiovascular disease mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Handgrip strength asymmetry, in addition to weakness, provided additional prognostic information for all-cause and cardiovascular mortality in older adults in the United States.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"758-767"},"PeriodicalIF":4.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}